Antihypertensive therapy with nisoldipine resulted in more Mis than therapy with enalapril in type 2 diabetes

Antihypertensive therapy with nisoldipine resulted in more Mis than therapy with enalapril in type 2 diabetes. Commentator, Malmberg, K., Ryden, L. and Wedel, H. Karolinska Hospital and Nordic School for Public Health, Stockholm, Sweden.
Evidence-based Medicine, 3(6); 191, Nov./Dec. 1998.

The following article is briefly reported.

The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. Estacio, R.O., Jeffers, B.W., Hiatt, W.R. et al
N Engl J Med, 338: 645-652, 5 Mar. 1998.

This was a subgroup analysis of a randomized, double-blind placebo-controlled trial (Appropriate Blood Pressure Control in Diabetes [ABCD] Trial). Nine hundred and fifty patients were randomized into the trial. Analysis occurred on 470 patients. The authors found that after 5 years of follow-up, more patients taking nisoldipine had Mis than those taking enalapril.

Commentary

Subgroup analysis and publication bias may affect these results. β-blockers were also used a lot in the enalapril group. However, FACET (Fosinopril versus Amlodipine Cardiovascular Events Trial) also found a better cardiovascular outcome with ACE inhibitors. It is unclear whether ACE inhibitors are beneficial or calcium channel blockers are detrimental. The commentators believe that the following should be used as first-line agents in hypertensive patients with diabetes β-blockers, diuretics or ACE inhibitors.

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